Delineating a putative phobic-anxious temperament in 126 panic-agoraphobic patients: toward a rapprochement of European and US views.
BACKGROUND
The current US official position, since DSM-III, is that panic attacks represent the hallmark of panic disorder and play a major role in the development of the agoraphobic syndrome. The more favoured view in the European tradition is that neurotic personality and/or prodromal features such as mild depression and excessive worries precede the illness.


METHODS
We studied 126 consecutive cases of panic disorder with or without agoraphobia by DSM-III-R criteria, evaluated by relevant structured and semi-structured interviews.


RESULTS
We provide evidence that characterological and prodromal antecedents represent a putative phobic-anxious temperamental substrate occurring in at least 30% of our sample. This temperament consists of three or more of the following traits: (1) increased sympathetic activity with repeated sporadic and isolated autonomic manifestations; (2) marked fear of illness; (3) hypersensitivity to separation; (4) difficulty to leave familiar surroundings; (5) marked need for reassurance; (6) oversensitivity to drugs and substances. Our data further suggest that these attributes are of familial origin, as a result of which the illness tends to declare itself earlier.


CONCLUSIONS
The present investigation is largely correlational without a prospective component; however, the key validating familial data were obtained blindly.


CONCLUSIONS
Our data support a pathogenetic model whereby genetic diathesis unfolds from subclinical to clinical manifestations along temperamental, panic, phobic and avoidant patterns. We submit that the delineation of the phobic-anxious temperament will be useful in more completely charting the life course of the panic-agoraphobic spectrum; avoidant and dependent (Axis II) patterns appear more distal in the pathogenetic chain and, in many cases, can be conceptualized to be epiphenomenal to the disease process.
Perugi
G
G
Institute of Psychiatry, University of Pisa, Italy.
Toni
C
C
Benedetti
A
A
Simonetti
B
B
Simoncini
M
M
Torti
C
C
Musetti
L
L
Akiskal
H S
HS
D000293:Adolescent; D000328:Adult; D017668:Age of Onset; D000379:Agoraphobia / Q000175:diagnosis* / Q000453:epidemiology / Q000209:etiology; D001008:Anxiety Disorders / Q000175:diagnosis / Q000235:genetics; D002648:Child; D002675:Child, Preschool; D015897:Comorbidity; D003431:Cross-Cultural Comparison; D005060:Europe; D005190:Family; D005260:Female; D020022:Genetic Predisposition to Disease; D006801:Humans; D007223:Infant; D008297:Male; D016584:Panic Disorder / Q000175:diagnosis* / Q000453:epidemiology / Q000209:etiology; D010554:Personality Disorders / Q000175:diagnosis* / Q000453:epidemiology / Q000235:genetics; D010698:Phobic Disorders / Q000175:diagnosis / Q000235:genetics; D012189:Retrospective Studies; D013694:Temperament / Q000145:classification*; D014481:United States